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1 A settings approach: a model of a health promoting workplace Kate Robertson Department of Health, NT Introduction The Northern Territory (NT) has the highest burden of disease among all jurisdictions in Australia and is increasing. 1 The burden of chronic diseases including cardiovascular disease, type II diabetes and cancer in the NT population is on a concerning upward trend. Modifiable lifestyle risk factors including poor nutrition, lack of physical activity, smoking and the harmful consumption of alcohol are responsible for a considerable proportion of the burden of disease and are the key to preventing poor health outcomes. 2 The World Health Organization (WHO) defines settings as the place or social context in which people engage in daily activities in which environmental, organizational and personal factors interact to affect health and well-being. 3 A settings approach to health promotion employs a social ecological framework to integrate health promotion strategies into the typical activities of the setting and to create a supportive environment which encourages healthy choices. 4 A health promotion settings approach has been undertaken in workplaces, schools, communities, prisons, hospitals and health services. A health promoting workplace addresses both individual risk factors and broader organisational and environmental issues which influence health. Policies, systems and practices conducive to health at all levels of the organisation are integrated to create a system and culture which supports and reinforces health. Health promotion in the workplace involves workers and managers taking action together to transform it into a health promoting setting. 5 NT Health (formerly Department of Health) employees over 5000 people to provide health care to all Territorians across the vast geographical area of the NT. is a health promoting workplace program which was piloted within NT Health between 2012 and Aim To reduce the risk of staff of developing a preventable chronic condition by increasing fruit and vegetable intake, increasing participation in physical activity, reducing tobacco use and reducing harmful consumption of alcohol. Methods In 2011, NT Health received funding from the Australian Government under the National Partnership Agreement on Preventive Health (NPAPH) to implement the workplace health promotion program for NT Health Staff. The program is a multi-strategy, workplace health promotion project targeting nutrition, physical activity, smoking and the harmful consumption of alcohol. The program sought to bring about positive changes in individual healthy lifestyle behaviours, create a supportive policy and physical environment within NT Health and establish a workplace culture that encourages healthy lifestyles. The NT Health Promotion Framework 6 was used as a planning tool to ensure program strategies targeted all levels of influence across the health promotion continuum. In addition capacity building techniques were integrated throughout the program plan to enhance its sustainability which aims to bring about long term effects. In order to facilitate active participation by NT Health staff in the planning, development, implementation and evaluation of the program, a working group was established. This group provided a mechanism by which staff representatives actively contributed to the structure of the program, selection of strategies and the determination of implementation and evaluation methods. The program plan was developed by the working group and presented to the Executive Leadership Team (ELT) of NT Health for endorsement and an opportunity to provide input into the planning, 13th National Rural Health Conference 1

2 implementation and evaluation of the program. Engagement with senior leadership was maintained by providing regular updates and briefings to the ELT. NT Health employees were provided with the opportunity to provide feedback and information regarding their preferences, perceived health needs and issues relating to barriers and implementation in local workplaces. Through consultation with regional reference groups, discussion of the project at Aboriginal Health Worker forum, team meetings and an online consultation survey, staff had the opportunity to provide advice and ideas and to shape the program. The strategies that made up targeted both individuals, groups, and the broader organisational and environmental issues. The principles of a health promoting workplace were incorporated into existing processes, structures and procedures. For examples existing policies relating to workplace health and wellbeing, newly developed policies and policies planned for development were brought together under one banner known as the Statement. Furthermore, workplace health and wellbeing was integrated as a key action into Workplace Health and Safety Strategy. Participation by NT Health employees was encouraged by providing the opportunity for staff to nominate themselves as workplace champions to assist in the development of programs in their workplace and support the implementation of broader strategies as part of the program. A network of workplace health and wellbeing champions was established to support champions in their voluntary roles with ongoing professional development and peer support. Results Increasing the capacity of NT Health to provide a healthy workplace environment through the development of processes, structures and procedures Statement The development of an overarching healthy workplace position statement for NT Health was a key strategy bringing together existing, newly developed and emerging policies relating to workplace health and wellbeing. The purpose of the Statement was to demonstrate the commitment of NT Health, as endorsed by the Chief Executive, to creating a supportive workplace environment which encourages healthier choices. It proved that NT Health highly values the health and wellbeing of its workforce and is committed to providing a workplace that encourages and supports staff to lead healthy lifestyles. Partnerships Another key strategy of was to develop collaborative partnerships with key stakeholders. In establishing a partnership with the Learning and Development Unit, a presentation to the leadership diploma and management certificate IV training course participants has been integrated into the course timetable. This avenue presents an ongoing opportunity to increase the awareness and knowledge of staff in leadership and management positions of their role in supporting workplace health and wellbeing. The integration of workplace health and wellbeing as a key focus action area into NT Health policies, guidelines, action plans, templates and training programs was a key strategy of the program. The aim was to develop supportive organisational practices which promoted health and wellbeing as being part of everyday business and every person s business. partnered with the Work Health and Safety (WHS) Unit to increase awareness and understanding of the link between health, wellbeing and one s ability to work safely. As a result Promote health and well-being was added as a strategy under Objective 4: Reduce the incidence and severity of occupational injury and illness of the Work Health and Safety Strategy Coupled to this, the WHS Unit promote and provide information about the program at staff orientation. The aim to increase staff awareness of NT Health as a health promoting workplace and where staff can access further information regarding program policies, activities and resources that support staff to make healthier lifestyle choices. 13th National Rural Health Conference 2

3 Network of Contacts The creation of partnerships with individual staff was another strategy to assist with implementation of strategies, distribution of information, and promotion related to program initiatives. This network of workplace contacts was comprised of: Workplace Health and Wellbeing Champions Healthy Lifestyle Sponsorship Fund recipients Healthy Lifestyle Sponsorship Fund steering committee members Work Health and Safety committee Chairpersons Working Group members Healthy Food and Drinks Policy In collaboration with the Nutrition and Physical Activity Strategy Unit (NPASU) the Healthy Food Choices - Healthy food and drink options for staff, volunteers and visitors in NT Health facilities policy was developed. This policy ensures consistency between the nutrition messages that NT Health promotes to the community and the foods and drinks provided or available for sale to staff, volunteers and visitors in all NT Health facilities. Importantly, it will ensure that healthy food and drinks options are available for staff and visitors at all times. Smoke Free Policy The Smoke Free Policy provides a safe work environment for staff, protects patients, visitors and staff from environmental tobacco smoke, and provides help for staff and patients to quit smoking. Implemented in 2009, was a member on the Smoke Free Implementation Steering Committee undertaking a review of the policy. Healthy Lifestyle Sponsorship Fund Another key strategy of the program was the development of the Healthy Lifestyle Sponsorship Fund (HLSF). This provided staff with an opportunity to access funding for programs, activities or equipment that supported healthy lifestyles and encouraged staff to have ownership over localised workplace based initiatives. It is estimated over 1000 staff participated in activities and accessed facilities or equipment funded under the HLSF program. Feedback from participants was overwhelmingly positive and there has been a strong demand for the strategy to continue. A summary of participant satisfaction of the program has been summarised into themes below: Improved physical condition and fitness Improved alertness and work productivity Improved levels of motivation to exercise Created an incentive to participate Group style fitness programs were very motivating and encouraging of participation, fostered team bonding both within their workplace and networking across the department Generated interest from people who did not normally engage in physical activity or that particular type of activity and inspired ongoing participation in non-hlsf physical activities into the future Staff highly valued the freedom to access equipment and facilities without cost and at a time convenient to the user Staff lunches have become healthier Staff have formed exercise groups, joining clubs and classes and purchasing sports equipment to continue their training/physical activity now that the HLSF has finished. 13th National Rural Health Conference 3

4 Workplace Health and Wellbeing Champions The aim of the Workplace Health and Wellbeing Champion training workshops were to build capacity among staff to create workplace environments that encourage, support and promote healthy lifestyle choices. This was achieved by enhancing the knowledge and skills of staff in the development, implementation and evaluation of sustainable workplace health and wellbeing programs in their work areas. The workshops were well received with the majority of participants reported that the quality of the training workshop and the facilitators were excellent, and that overall the workshop was very informative and motivating. Twenty One staff from the Top End and 10 from Central Australia attended. Coupled to this is the establishment of the Champion Network. Its function is to enable opportunities for professional development and peer-to-peer support amongst Champions. Intranet site The intranet site was developed to promote and encourage staff to practice healthy lifestyle choices by providing centralised access to information, screening tools and resources relating to nutrition, physical activity, smoking cessation and healthy alcohol consumption. In addition it will house an electronic toolkit containing a resource guide to assist staff to plan, develop, implement and evaluate health and wellbeing programs and a resource to support the reduction of smoking and harmful consumption of alcohol amongst employees. The intranet site has been viewed by NT Health staff over 8300 times since its launch in September Intranet analytic reports reveal the most popular page destinations were: Healthy Lifestyle Sponsorship Fund Recipe of the month Staff Noticeboard Healthy Weight Week - Online healthy weight program Position Statement Staff Profile - Healthy Weight Week Communication The communication strategy aimed to provide consistent and clear communication to NT Health staff regarding the project via regular intranet newsreel updates, promotion and maintenance of the intranet site, updates through WHS Committees and the development of a generic . Providing consistent communication to staff across NT Health was challenging due to complex approval processes, staff being based across multiple urban, rural and remote locations of the NT and some staff not having a work account or limited computer access. Encouraging managers and other staff to communicate messages to those staff without computer access was a strategy employed to manage this issue, however this was not effective. For example, verbal feedback from some hospital based staff revealed that they had not once heard of nor seen information relating to Other communication avenues such as the WHS committees, Champion Network, HLSF applicants, Working Group members, and HLSF committee members were also utilised to help distribute information. Risk Profiling Project The purpose of the Risk Profiling Study was to assess the prevalence of lifestyle risk factors among NT Health staff and the barriers Aboriginal and Torres Strait Islander employees face in engaging in healthy lifestyles. The qualitative component of the study aimed to gather information specifically relating to the barriers and challenges faced by NT Health Aboriginal and Torres Strait Islander staff. Key findings from the report include: Family behavioural norms can influence, or in some cases, add stress to an individual s use (or non-use) of cigarettes or alcohol. Furthermore, some of the participants found it easier to conform to the pattern of life with their family and friends while in their company even though they would like to give up smoking/drinking. While participants were aware that they could access strategies and medication to support them to quit smoking, there was little evidence to suggest they were actively doing so. 13th National Rural Health Conference 4

5 Most of the participants did not see supporting their health as a primary concern of NT Health. So there was some uncertainty about what NT Health could do to help them. Stress was a major health factor in participant s minds. It reported to be strongly associated with the practice of unhealthy lifestyle behaviours such as smoking and harmful alcohol consumption and conversely is a barrier to changing those same practices. Stress was reported to stem from issues in the workplace and pressures inherent in the participants work roles as well as systemic issues including housing, overcrowding, remote locality, family and cultural responsibilities. Furthermore, they expressed that family and cultural ways of coping with stress was a more effective route for them compared to western approaches. In terms of improving their nutrition participants felt most strongly about the standard and type of food available in hospital canteens on the one hand and their ability to access bush tucker on the other. It was felt that the health checks by visiting doctors was beneficial in identifying early warning of possible illnesses and also was a reminder to them of their own potential health issues. Decreasing the risk profile of staff for developing a preventable chronic condition The quantitative component of the study consisted of a descriptive longitudinal study of health behaviours in staff across NT Health. Health behaviours were measured via staff survey at baseline in 2012 and then again A summary of the results are presented below: A 4% increase was observed in the proportion of staff (21%) whom reported meeting the recommended daily intake of vegetables (up from 17% at baseline). A similar increase of 4% was observed in staff who met the daily recommended intake of fruit (69% up from 65%) An increase of 6% in the number of staff who reported having sedentary work roles. This represented over three quarters of survey responders (76% up from 70% at baseline). The overall smoking rate of 13% remained steady from baseline. Almost two thirds of respondents fell into the overweight or obese category, a 4% increase from baseline (61% up from 57%). The percentage of staff whom reported meeting the recommended 150 mins of moderate physical activity in the preceding week has remained steady at 40% An increase in harmful levels of alcohol consumption. The percentage of staff who consumed 2 standard drinks or less (on the most recent day they drank alcohol) decreased by 6% to 57%. However, there was an increase of 3% of staff (to 27%) reported to have consumed between 3 and 4 standard drinks (on the most recent day they drank alcohol). Furthermore, an increase of 3% was also observed amongst those reporting to have consumed 5 or more standard drinks, now 16%. Discussion The strengths of the program warrant further development and evaluation for wider program roll-out. organisational processes, structures and procedures have increased the capability of NT Health to create a supportive workplace environment which supports staff to make healthier lifestyle choices. This is evidenced by endorsement of the Statement from the Chief Executive and ongoing engagement from the ELT. Signoff from the highest level was a powerful lever used to encourage staff participation. Similarly, the partnership with the Learning and Development Unit to garner the support of leaders and managers for workplace health and wellbeing and encourage their active engagement in the program s activities is likely to have brought about a higher level of employee engagement and enthusiasm. 7 Furthermore, s partnership with the WHS Unit warrants ongoing development to continue the development of an organisational culture which understands and values the link between wellbeing and one s ability to work safely. 13th National Rural Health Conference 5

6 Utilising the NT Health Promotion Framework and health promoting workplace best practice principles to inform the design of the model will ensure its sustainability even without ongoing funding. Whereas, if the Healthy Workers Initiative project was developed in isolation, it is unlikely it would be able to continue. The Healthy Lifestyle Sponsorship Fund (HLSF) is considered an effective strategy of the program. It had high levels of engagement and participant satisfaction. Awareness amongst staff of and hence NT Health s commitment to creating a supportive workplace environment which encourages healthier choices is attributed to the success of this initiative. Most importantly, the opportunity to access funding for programs, activities or facilities that support healthy lifestyles enabled staff to take ownership over planning localised and sustainable workplace based initiatives that met their needs. Staff based in urban areas used this as an opportunity to become familiar and confident with local facilities and activities and for those in isolated areas it supplied lasting infrastructure. has increased the capacity of staff to address risk factors for preventable chronic conditions. The train-the-trainer Workplace Health and Wellbeing Champion Training workshop is a sustainable training system for increasing capability to implement or advance workplace health and wellbeing programs across work areas. The two day workshop was economical to deliver and accessible for staff to attend. The skills and resources obtained enable Champions to help train future Health and Wellbeing Champions within their own work areas. The intranet site has been a successful resource in supporting and encouraging healthier choices in the workplace. This resource will form the basis of the future development of web based online resource and training portal containing workplace health and wellbeing self-paced learning modules to support staff in planning, development, implementation and evaluation of health and wellbeing programs within the workplace. Internal and external challenges faced in providing consistent and clear communication to NT Health staff regarding implementation of the project are surmountable barriers. Staff working within the hospitals of NT Health are a key target group with potentially different communication and program activity needs. Direct partnership and engagement with representatives of staff groups within the hospital setting on a specific communication strategies is envisioned would significantly increase staff engagement and participation. Conclusion as a Health Promoting Workplace program has succeeded in increasing awareness, engagement and capability amongst staff with regard to workplace health and wellbeing in the workplace. The attainment of sustainable skills, development of organisational structures and resources and a commitment to health by the organisation will enable NT Health and its staff to continue addressing their risk for developing preventable chronic conditions. A sustainable Health Promoting Workplace model has been piloted which, with further development and evaluation, could contribute to bringing about long term benefits. The opportunity to pilot as a model of a health promoting workplace will result in the development of the online toolkit which is suited to support a wider roll-out across the NT. Recommendations Actionable recommendations for future development of the model include: The project communication strategy must be developed in collaboration with key stakeholders of the project that represent all staff groups across the organisation. This will ensure the project is successful at achieving its target population reach. Participant feedback of the Champion training workshop and Champion Network expressed great value, appreciation and increased motivation to participate upon receiving training and workplace based team support. This strategy although undeveloped and time intensive, is identified as a strength which warrants further development. 13th National Rural Health Conference 6

7 Implement findings of the qualitative component of the Risk Profiling Project. Advocate for the continuation of the Healthy Lifestyle Fund References 1. Department of Health and Families, Northern Territory Chronic Conditions Prevention and Management Strategy, Department of Health and Families, Darwin, National Preventative Health Taskforce, Australia: The Healthiest Country by 2020, Commonwealth of Australia, Canberra, World Health Organization, The WHO Health Promotion Glossary, World Health Organization, Geneva, M. Mittelmark, Unintended effects in settings-based health promotion, Scandinavian Journal of Public Health, vol. 42, no. 15, pp , C. Chu, G. Breucker, N. Harris, A. Stitzel, X. Gan, X. Gu and S. Dwyer, Health-promoting workplaces-international settings development, Health Promotion International, vol. 15, no. 2, p. 14, Department of Health, Northern Territory Health Promotion Framework, Department of Health, Darwin, WorkCover Tasmania, Your simple guide to workplace health and wellbeing, Hobart: WorkCover Tasmania, B. Poland, G. Krupa and D. McCall, Settings for Health Promotion: An analytic framework to guide intervention design and implementation, Health Promotion Practice, vol. 10, no. 4, pp , Presenter Kate Robertson has worked in Health Promotion and Public Health Nutrition over the last six years. She has worked for the Department of Health during this time, with four years based in Katherine as a Public Health Nutritionist/Dietitian and for the past two years has been coordinating the Project in Darwin. Kate is currently the Training and Education Program Development Officer with the Health Promotion Strategy Unit for the Northern Territory Department of Health and is responsible for providing expert advice and guidance on health promotion policy and program development for health promotion education, training and workforce development. Kate holds a Batchelor of Nutrition and Dietetics and is currently studying a Masters in Public Health and Masters in Business Administration. 13th National Rural Health Conference 7

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